Frank Häßler’s research while affiliated with Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e.V. and other places

Zusammenfassung Fragestellung Delinquentes Verhalten ist ein häufiges Phänomen in der Entwicklung von Kindern und Jugendlichen und stellt in der Kinder- und Jugendpsychiatrie bzw. -psychotherapie keinen seltenen Vorstellungsgrund dar. Allerdings fehlen empirische Untersuchungen zur Versorgungssituation von delinquenten Kindern und Jugendlichen in Deutschland. Mit der vorliegenden Untersuchung wurde erstmals deutschlandweit versucht zu erfassen, wie häufig im Bereich der Kinder- und Jugendpsychiatrie und -psychotherapie Behandler_innen mit delinquentem Verhalten ihrer Patient_innen konfrontiert sind, welche Versorgungskonzepte bestehen, und in welchem Umfang eine gutachterliche Tätigkeit erfolgt. Methodik Im Rahmen einer Online-Befragung äußerten sich insgesamt 217 Fachkräfte aus dem Bereich der Kinder- und Jugendpsychiatrie und -psychotherapie dazu, wie häufig, in welchen Kontexten (Begutachtung, [teil-]stationäre und ambulante Versorgung) und mit welchen Methoden sie mit delinquenten Kindern und Jugendlichen arbeiten. Ergebnisse Aus den Angaben ließ sich ableiten, dass Kinder- und Jugendpsychiater_innen und -psychotherapeut_innen zwar regelmäßig mit delinquenten Minderjährigen zu tun haben, es aber gleichzeitig nur wenige spezialisierte Behandlungsangebote zu geben scheint. Außerdem bildete sich hinsichtlich der gutachterlichen Tätigkeiten eine große Heterogenität hinsichtlich Quantität und Methoden ab. Schlussfolgerungen Implikation für die Praxis im Sinne der Erweiterung und Spezifizierung entsprechender Angebote für delinquente Kinder und Jugendliche, aber auch in Bezug auf die Sicherstellung der Qualifizierung der für sie zuständigen Fachkräfte, werden diskutiert.

Zusammenfassung Anhand einer Fallvignette, in der die Begutachtung eines minderjährigen Straftäters mit einer tuberösen Sklerose (TS) beschrieben wird, geht es um die Kriterien der Verantwortungsreife nach § 3 JGG (Jugendgerichtsgesetz) und die Eingangskriterien der §§ 20/21 StGB (Strafgesetzbuch). Explizit wird der Frage nachgegangen, inwieweit auch beim Vorliegen einer (schweren) genetischen Erkrankung nicht per se von einer fehlenden Verantwortungsreife bzw. der Erfüllung der Eingangskriterien der §§ 20/21 StGB auszugehen ist. Der direkte Schluss von einer genetischen Konstellation auf ein Tatverhalten stellt einen nicht zu unterschätzenden gutachterlichen Fehler dar.

Background: Methylphenidate is the most frequently prescribed medication for the treatment of ADHD in children and adolescents in many countries. Although many randomised controlled trials support short-term efficacy, tolerability, and safety, data on long-term safety and tolerability are scarce. The aim of this study was to investigate the safety of methylphenidate over a 2-year period in relation to growth and development, psychiatric health, neurological health, and cardiovascular function in children and adolescents. Methods: We conducted a naturalistic, longitudinal, controlled study as part of the ADDUCE research programme in 27 European child and adolescent mental health centres in the UK, Germany, Switzerland, Italy, and Hungary. Participants aged 6-17 years were recruited into three cohorts: medication-naive ADHD patients who intended to start methylphenidate treatment (methylphenidate group), medication-naive ADHD patients who did not intend to start any ADHD medication (no-methylphenidate group), and a control group without ADHD. Children with ADHD diagnosed by a qualified clinician according to the DSM-IV criteria and, in the control group, children who scored less than 1·5 on average on the Swanson, Nolan, and Pelham IV rating scale for ADHD items, and whose hyperactivity score on the parent-rated Strengths and Difficulties Questionnaire was within the normal range (<6) were eligible for inclusion. Participants were excluded if they had previously taken any ADHD medications but remained eligible if they had previously taken or were currently taking other psychotropic drugs. The primary outcome was height velocity (height velocity SD score; estimated from at least two consecutive height measurements, and normalised with reference to the mean and SD of a population of the same age and sex). Findings: Between Feb 01, 2012, and Jan 31, 2016, 1410 participants were enrolled (756 in methylphenidate group, 391 in no-methylphenidate group, and 263 in control group). 1070 (76·3%) participants were male, 332 (23·7%) were female, and for eight gender was unknown. The average age for the cohort was 9·28 years (SD 2·78; IQR 7-11). 1312 (93·0%) of 1410 participants were White. The methylphenidate and no-methylphenidate groups differed in ADHD symptom severity and other characteristics. After controlling for the effects of these variables using propensity scores, there was little evidence of an effect on growth (24 months height velocity SD score difference -0·07 (95% CI -0·18 to 0·04; p=0·20) or increased risk of psychiatric or neurological adverse events in the methylphenidate group compared with the no-methylphenidate group. Pulse rate and systolic and diastolic blood pressure were higher in the methylphenidate group compared with the no-methylphenidate group after 24 months of treatment. No serious adverse events were reported during the study. Interpretation: Our results suggest that long-term treatment with methylphenidate for 2 years is safe. There was no evidence to support the hypothesis that methylphenidate treatment leads to reductions in growth. Methylphenidate-related pulse and blood pressure changes, although relatively small, require regular monitoring. Funding: EU Seventh Framework Programme.

Attention deficit hyperactivity disorder (ADHD) is a very common disorder in children and adults. A connection with sleep disorders, and above all, disorders of the circadian rhythm are the subject of research and debate. The circadian system can be represented on different levels. There have been a variety of studies examining 24-h rhythms at the behavioral and endocrine level. At the molecular level, these rhythms are based on a series of feedback loops of core clock genes and proteins. In this paper, we compared the circadian rhythms at the behavioral, endocrine, and molecular levels between children with ADHD and age- and BMI-matched controls, complementing the previous data in adults. In a minimally invasive setting, sleep was assessed via a questionnaire, actigraphy was used to determine the motor activity and light exposure, saliva samples were taken to assess the 24-h profiles of cortisol and melatonin, and buccal mucosa swaps were taken to assess the expression of the clock genes BMAL1 and PER2. We found significant group differences in sleep onset and sleep duration, cortisol secretion profiles, and in the expression of both clock genes. Our data suggest that the analysis of circadian molecular rhythms may provide a new approach for diagnosing ADHD in children and adults.

Objective People with intellectual disabilities (ID) are at higher risk of being sexually abused and developing psychiatric disorders in consequence. The effects of behavior prevention programs for children with ID have rarely been investigated. Previous studies suffer from methodical weaknesses, such as the lack of a control group, small sample size, or invalid outcome measures. This study aimed at demonstrating the efficacy of a prevention program by overcoming these flaws. Methods A group prevention program was developed and evaluated. One hundred and six girls aged from 8 to 12 years with mild ID were enrolled in a randomized controlled study, comparing the training to a sham intervention. Effects were examined in a three-time follow-up design as individual changes in preventive knowledge (board game, verbal reports) and preventive behavior (role-play, in situ tests). Participants' behaviors were videotaped and rated by three blinded raters. Results Girls from the intervention group (n = 64) showed significant improvements in preventive knowledge compared with the control group (n = 39) but showed non-significant improvements for preventive behavior. In situ tests with realistic seduction situations revealed no improvement. The intervention proved to be safe, but several risks need to be considered. Discussion This is the first study that evaluates a behavioral prevention program on sexual abuse for children with ID on a high level of evidence. Group interventions empowering girls with ID to recognize abuse situations are suitable to enhance sexual preventive knowledge but are less suitable to enhance preventive behavior. Naturalistic settings are indispensable for providing evidence for preventive interventions in children with ID.